Musculoskeletal and Rheumatologic — Repetitive strain injuries

A 46-year-old woman comes to the family physician's office with 6 weeks of gradual-onset pain over the outer right elbow. She has trouble lifting a full kettle and gripping her racquet. She plays recreational tennis twice weekly and works at a computer with a mouse for most of the day. She has a history of peptic ulcer disease with a gastrointestinal bleed 3 years ago, treated with Helicobacter pylori eradication. She takes no regular medications and has no known allergies. On examination, there is maximal tenderness just distal to the lateral epicondyle. Pain is reproduced with resisted wrist extension and resisted middle-finger extension. Elbow range of motion is full with no locking, swelling or warmth, and the neurological examination of the arm is normal.